Near Miss of Aortic Stenosis in Setting of Spinal Canal Stenosis: Not Just Another Fall

Title : Near Miss of Aortic Stenosis in Setting of Spinal Canal Stenosis: Not Just Another Fall

Abstract:

Introduction: Syncope is a transient loss of consciousness with several possible causes. Aortic stenosis is one of the most common causes of syncope in elderly patients.

Case Presentation: A 65-year-old female patient presents with a chief complaint of a fall. She had an abrupt loss of consciousness at rest with regain in less than a minute. She has a history of spinal canal stenosis and multiple past visits for recurrent falls. An ejection systolic murmur grade 2 is present in the right upper sternal border, radiating throughout the precordium. Electrocardiogram showed normal sinus rhythm, left axis deviation, and right bundle branch block. Cardiac troponins were normal.

Results: Echocardiogram showed normal ejection fraction and heavy calcification of the aortic valve with the restricted opening. Visually, moderate aortic stenosis was seen. Based on the gradient and aortic valve area, the patient had severe aortic stenosis.

Decision making: The cardiology team was consulted. Due to the presence of coronary risk factors and discrepancy in findings, cardiac catheterization was done prior to further decision-making on valve replacement. It showed moderate nature of the stenosis and no coronary artery disease. In view of symptomatic aortic stenosis, the patient was evaluated for aortic valve replacement via shared decision making.

Conclusions: Severe aortic stenosis can manifest as recurrent syncopal episodes, especially in elderly patients. It can be easily confused as benign fall, in patients with spinal canal stenosis. A meticulous history taking and physical exam lead to prompt diagnosis and management.

What will audience learn from your presentation?

• Fall is a common manifestation in elderly population.
• Cardiac causes are often missed in the setting of preexisting other causes, such a spinal canal
stenosis.
• A meticulous history taking, and physical exam can lead to catch of serious underlying etiology such
as aortic stenosis
• A timely investigation and management of valvular heart disease, such as aortic stenosis, saves a
patient from life threating complications such as sudden cardiac death.

Biography:

Dr. Shikha Jha completed her medical school from National Medical College, Nepal. She worked as a medical officer in Nepal for 2 years. She completed Global Clinical Scholars Research Training from Harvard Medical School, Boston, MA, USA in 2020. She joined residency in Internal Medicine at Saint Peter’s University Hospital, New Jersey, USA in 2020. She is currently 2nd year medical resident. She wants to pursue cardiology in future. She enjoys enhancing her research skill in this subspecialty via writing papers and attending national and international conferences. She has published several articles in cardiology topics.